Clinical features of respiratory adenovirus infections in pediatric inpatients in a single medical center

Tae Hyun Kim; Chung Hyuk Yim; Sung Yoon Ahn; Kook Jin Kang; Yu Mi Choi; Jeong Hee Ko; Kyong Eun Choi; Jung Hyun Lee; Won Wook Lee

doi:10.4168/aard.2015.3.6.402

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Kim, Yim, Ahn, Kang, Choi, Ko, Choi, Lee, and Lee: Clinical features of respiratory adenovirus infections in pediatric inpatients in a single medical center

Original Article

Allergy, Asthma & Respiratory Disease 2015; 3(6): 402-409.

Published online: 30 November 2015

DOI: https://doi.org/10.4168/aard.2015.3.6.402

Clinical features of respiratory adenovirus infections in pediatric inpatients in a single medical center

Tae Hyun Kim, Chung Hyuk Yim, Sung Yoon Ahn, Kook Jin Kang, Yu Mi Choi, Jeong Hee Ko, Kyong Eun Choi, Jung Hyun Lee

, Won Wook Lee

Department of Pediatrics, Gwangmyeong Sungae Hospital, Gwangmyeong, Korea.

Correspondence to: Jung Hyun Lee. Department of Pediatrics, Gwangmyeong Sungae Hospital, 36 Digital-ro, Gwangmyeong 14241, Korea. Tel: +82-2-2680-7215, Fax: +82-2-2680-7755, pedjunghyun@naver.com

Received 12 June 2015 Revised 24 August 2015 Accepted 24 August 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).

Abstract

Purpose

The purpose of this study is to identify the epidemiologic and clinical characteristics of respiratory adenovirus infections in children, and to investigate the difference in the clinical features between single adenovirus infection and coinfection with adenovirus and other respiratory viruses.

Methods

A retrospective study was performed in 470 children hospitalized with respiratory adenovirus infections in Gwangmyeong Sungae Hospital between January 2013 and December 2013.

Results

The mean age of the patients was 46.2 months and the peak incidence was in the 12- to 24-month age group. The mean duration of hospitalization and fever were 4.5±1.1 and 4.5±9.2 days, respectively. Seasonally it had occurred throughout the year, but showed the highest prevalence in August and high prevalence in July, September, and October. The frequency of viral coinfection with other respiratory viruses was 39.6%. The age was significantly younger in coinfection group than in the single adenovirus infection group (P<0.001). The prevalence rates of bronchiolitis (P<0.001) and pneumonia (P=0.042) were significantly higher in the respiratory syncytial virus coinfection group. The coinfection rate was significantly higher in children aged less than 2 years (P<0.001), and the prevalence rates of bronchiolitis (P<0.001) and pneumonia (P<0.001) were also higher in the group aged less than 2 years than other age groups.

Conclusion

Adenovirus is an important viral agent in hospitalized children with acute respiratory tract infection. Lower respiratory tract infections, such as bronchiolitis and pneumonia, and coinfection with other respiratory viruses were more frequently occurred in patients under 2 years of age. Further studies are needed to clarify whether coinfection with other respiratory viruses would increase the rate of lower respiratory tract infections in patients with respiratory adenoviral infections.

Keywords: Adenovirus, Respiratory adenoviral infection, Coinfection, Child, Hospitalization

Figures and Tables

Fig. 1

Age distribution in children with adenoviral infection

Fig. 2

Monthly distribution in children with adenoviral infection.

Table 1

Clinical characteristics of patients with adenoviral infection and comparison of clinical characteristics between patients with single and multiple infection

Variable	Total (n=470)	AdV group (n=297)	Coinfection group (n=173)	P-value	Coinfection group
Variable	Total (n=470)	AdV group (n=297)	Coinfection group (n=173)	P-value	RV coinfection (n=100)	P-value^*	RSV coinfection (n=37)	P-value^†
Age (mo)	46.2 ± 32.6	51.5 ± 34.2	37.2 ± 27.6	< 0.001	38.2 ± 26.0	< 0.001	28.0 ± 25.9	< 0.001
Hospitalization	4.5 ± 1.1	4.5 ± 1.1	4.6 ± 1.2	0.443	4.4 ± 1.1	0.323	5.3 ± 1.6	< 0.001
Symptoms & signs
Fever ( > 38℃)	453 (96.4)	291 (98.0)	162 (93.6)	0.015	95 (95.0)	0.081	33 (91.6)	0.012
High fever ( > 39℃)	300 (63.8)	199 (67.0)	101 (58.4)	0.072	54 (54.0)	0.001	14 (37.8)	< 0.001
Mean duration of fever	4.5 ± 9.2	4.1 ± 9.9	5.1 ± 7.9	0.305	4.5 ± 2.7	0.763	4.4 ± 4.1	0.890
Prolonged high fever ( > 10 days)	10 (2.1)	5 (1.7)	5 (2.9)	0.674	2 (2.0)	0.695	1 (2.7)	0.373
Cough	280 (59.6)	162 (54.9)	118 (68.2)	0.004	70 (70.0)	0.008	28 (77.8)	0.008
Rhinorrhea	273 (58.1)	151 (51.2)	122 (70.1)	< 0.001	75 (75.0)	< 0.001	29 (80.6)	< 0.001
Dyspnea/tachypnea	7 (1.5)	2 (0.7)	5 (2.9)	0.106	3 (3.9)	0.104	1 (2.7)	0.291
Conjunctival injection	113 (24.0)	72 (24.2)	30 (17.3)	0.08	19 (19.0)	0.287	5 (13.9)	0.164
Vomiting	72 (15.3)	55 (18.5)	17 (9.8)	0.011	8 (8.0)	0.012	6 (16.7)	0.786
Diarrhea	55 (11.7)	38 (9.4)	27 (15.7)	0.042	8 (8.0)	0.686	9 (25.0)	0.010
Seizure	22 (4.7)	14 (4.7)	8 (4.6)	0.964	4 (4.0)	1.000	4 (11.1)	0.116
Clinical diagnosis
URTI	352 (74.9)	239 (80.5)	113 (65.3)	< 0.001	71 (71.0)	0.102	14 (37.8)	< 0.001
LRTI	118 (25.1)	58 (19.5)	60 (34.7)	< 0.001	29 (29.0)	0.102	23 (62.2)	< 0.001
Bronchitis	23 (4.9)	12 (4.0)	11 (6.4)	0.262	5 (5.0)	0.389	3 (8.1)	0.187
Bronchiolitis	25 (5.3)	11 (3.7)	14 (8.1)	0.041	6 (6.0)	0.144	11 (29.8)	< 0.001
Pneumonia	70 (14.9)	35 (11.8)	35 (20.2)	0.022	18 (18.0)	0.173	9 (24.3)	0.042
Laboratory findings
WBC (/µL)	11,277 ± 4,958	11,126 ± 4,299	11,126±4,299	0.737	11,523 ± 5,024	0.786	9,911 ± 3,350	0.106
Hemoglobin (g/dL)	12.5 ± 1.1	11.8 ± 1.1	11.8±1.1	0.381	11.9 ± 1.0	0.103	12.1 ± 1.0	0.591
CRP (mg/dL)	5.1 ± 4.0	2.8 ± 2.7	2.8±2.7	< 0.001	3.3 ± 3.0	< 0.001	1.4 ± 1.6	< 0.001
AST (IU/L)	32.7 ± 20.2	39.7 ± 50.9	39.7±50.9	0.036	32.9 ± 9.5	0.889	56.5 ± 84.3	< 0.001
ALT (IU/L)	19.6 ± 27.4	25.1 ± 58.6	25.1±58.6	0.163	18.4 ± 9.7	0.685	45.1 ± 112.8	0.001

Values are presented as mean±standard deviation or number (%). Student t-test, chi-square test, and Fisher exact test were used to assess the differences between AdVs group and coinfection group.

AdV, adenovirus; RV, rhinovirus; RSV, respiratory syncytial virus; URTI, upper respiratory tract infection; LRTI, lower respiratory tract infection; WBC, white blood cell; CRP, C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase.

^*Comparison between Adv group and RV coinfection group. ^†Comparison between Adv group and RSV coinfection group.

Table 2

Frequency of codetection of respiratory viruses in hospitalized children with respiratory adenoviral infection

Virus	No. of positive (%)
Influenza A	9 (4.8)
RSV	37 (19.9)
Rhinovirus	100 (53.8)
Parainfluenza virus	12 (6.4)
Metapneumovirus	10 (5.4)
Coronavirus	13 (7.0)
Bocavirus	5 (2.7)
Total virus positive	186^* (100)

RSV, respiratory syncytial virus.

^*A total of 186 viruses were detected from 172 patients and more than 3 viruses were detected in 14 patients.

Table 3

Comparison of clinical characteristics in different age groups

Variable	Age group (yr)			P-value
Variable		2-5 (n=209)	>5 (n=129)	P-value
Hospitalization (day)	4.5 ± 1.1	4.6 ± 1.1	4.5 ± 1.2	0.666
Coinfection	72 (54.5)	69 (33.0)	32 (24.8)	< 0.001
Symptoms & signs
Fever ( > 38℃)	127 (96.2)	202 (96.7)	124 (96.1)	0.737
High fever ( > 39℃)	80 (60.6)	139 (66.5)	81 (63.0)	0.072
Mean duration of fever	4.9 ± 2.9	5.0 ± 7.8	3.1 ± 14.1	0.172
Prolonged high fever ( > 10 days)	5 (3.8)	3 (1.4)	2 (1.6)	0.104
Cough	83 (62.9)	133 (63.9)	64 (50.0)	0.028
Rhinorrhea	87 (74.2)	128 (61.5)	47 (37.0)	< 0.001
Dyspnea/tachypnea	1 (0.8)	3 (1.4)	2 (1.6)	0.884
Conjunctival injection	22 (16.7)	46 (22.0)	34 (26.3)	0.163
Vomiting	17 (12.9)	34 (16.2)	21 (16.3)	0.656
Diarrhea	23 (17.6)	21 (10.1)	11 (8.5)	0.046
Seizure	7 (5.3)	14 (6.7)	1 (0.8)	0.040
Clinical diagnosis
URTI	81 (61.4)	154 (73.7)	117 (90.7)	< 0.001
LRTI	51 (38.6)	55 (26.3)	12 (9.3)	< 0.001
Bronchitis	6 (4.5)	14 (6.7)	3 (2.3)	0.296
Bronchiolitis	16 (12.1)	9 (4.3)	0 (0)	< 0.001
Pneumonia	29 (22.0)	32 (15.3)	9 (7.0)	< 0.001
Laboratory findings
WBC (/µL)	11,796 ± 5,602	11,253 ± 4,470	10,583 ± 4,044	0.115
Hemoglobin (g/dL)	11.8 ± 1.2	12.1 ± 1.0	12.5 ± 1.1	0.181
CRP (mg/dL)	2.7 ± 2.6	4.8 ± 4.2	5.0 ± 3.5	< 0.001
AST (IU/L)	47.1 ± 58.3	33.0 ± 21.2	27.0 ± 7.1	< 0.001
ALT (IU/L)	33.4 ± 69.3	17.9 ± 26.6	15.8 ± 11.1	0.001

Values are presented as number (%) or mean±standard deviation. One way analysis of variance, chi-square test, and Fisher exact test were used to assess the differences in different age groups.

URTI, upper respiratory tract infection; LRTI, lower respiratory tract infection; WBC, white blood cell; CRP, C-reactive protein; AST, aspartate aminotransferase; ALT, alanine aminotransferase.

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ORCID iDs: Jung Hyun Lee
https://orcid.org/http://orcid.org/0000-0002-2118-0229
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